Change and Hope in Pakistan: Strengthening the Education, Careers and Lives of Nurses and Midwives

By Fauzia Assad and Pauline Lubens

Islamabad, Pakistan -- For young women in Pakistan’s rural areas, a career in nursing can be a start on a path to empowerment, as well as to a life spent meeting their community’s health care needs.

Through Jhpiego’s partnership with the Family Advancement for Life and Health (FALAH) project, many of the students at institutions such as the School of Midwifery and Nursing in Mardan will be the first women in their families to have careers.

“We will be more empowered mothers than our own mothers,” says Saadia, a student from the Mardan School of Nursing, which is in Khyber Pakhtunkhwa province in Pakistan’s northwest.

FALAH, a national initiative of the Government of Pakistan and the U.S. Agency for International Development (USAID), offers a curriculum that features training in contraceptive technology, client-centered counseling and the importance of "healthy timing and spacing of pregnancy." Project partners include Jhpiego, the Population Council/Pakistan, Mercy Corps, Save the Children, Health and Nutrition Development, Greenstar Social Marketing, Rural Support Programmes Network and others.

Dr. Mehmooda Nasreen, the principal of the School of Midwifery and Public Health in Dera Ghazi Khan, is confident that the FALAH project will help send young women into the world prepared to make a difference in their own lives and that of their communities. Through the program, she says, the school’s curriculum equips students with the practical training that will enable them to handle obstetric emergencies in clinics, to plan their own families and to be the decision-makers when it comes to the health of their children.

In Pakistan, a woman has a 1 in 74 lifetime risk of dying from maternal causes, and 276 women die from childbirth-related causes per 100,000 live births.

“FALAH prepares students for the real world by giving them the clear message not to marry early,” Dr. Nasreen explains, and to put their FALAH-supported family planning training to use in their own lives. “That will improve their health as well as the educational and economic status of their families.”

Sahzia, 18, from Pind Dadan Khan in the Jehlum district, describes how the program has influenced her: “I’m confident that I can now be a better service provider and educate my community about family planning.”

For Hania, a 19-year-old student from Jehlum City, enrolling in the school was a sign not only of personal achievement, but also of generational change. Her father, who runs a grocery store, supported her dream of becoming a nurse despite opposition from other relatives, social pressure and the family’s limited resources.

For the faculty at the school, as part of FALAH, Jhpiego created a hands-on, skills-centered course of study that has allowed them a chance to continue furthering their education and created a more collaborative atmosphere. Dr. Nasreen explains that through the program, teachers are encouraged to make on-site visits to clinics so they may assist providers in honing the skills they learned in the lab (part of the skills training component of the course) by working with Jhpiego-trained faculty.

In addition, teachers have become invested in the project because they helped shape its goals and objectives. “Our whole faculty and clinical preceptors have been involved in the project from day one and we have a feeling of owning the whole process,” says Dr. Nasreen. “Jhpiego has made us a part of their family and guided us in every step of implementation, with the support of the Pakistan Nursing Council,” which is the autonomous regulatory body that oversees operations of all schools.

Nursing educators across several provinces praised the impact of Jhpiego’s partnership with the FALAH project, which ended this month.

For example, Shakila Begum, of the Pakistan Nursing Council, says that the FALAH project has provided the organization with an opportunity to identify the international standards of nursing competencies and the channels for acquiring them. She adds that she hopes to replicate the FALAH–Jhpiego family planning training model for Pediatric Nursing and other postgraduate nursing courses.

In the Lahore-Punjab region, Shehnaz Zaidi credits the project’s practical training and the “humanistic technique” with burnishing the reputation of nurses in remote communities, where the public is more likely to trust doctors rather than midwives or nurses. She also appreciates the project’s involvement of faculty in developing the curriculum and for providing “unconditional support.”

The FALAH project has helped change the way in which students learn, according to Dr. Syed Hasan Shoaib, a program advisor for Jhpiego. “We have tried to include case studies so that the focus should shift from rote learning to problem-solving,” which is in line with evidenced-based practices in education and training.

In Balochistan, Fatima Nasreen says FALAH has boosted the quality of nursing education—something long neglected there: “All we need is to implement this effort in true spirit. I feel myself lucky to be part of this great process.”

Dr. Mehmooda Nasreen, Dera Ghazi Khan, also credits the partnership with creating public awareness of the importance of pre-pregnancy health care, health insurance for low-income women and an improvement in program research and monitoring.

“If we really want to bring any change in our country’s health indicators, then we have to update our knowledge and practices for teaching and service delivery. I am extremely thankful to FALAH and Jhpiego,” Dr. Nasreen says. “Definitely, in a time to come, we will be able to make a difference.”

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